Gliederung

Purpose: Even though Queensland has the highest incidence of trauma of all Australian states, the allocation of a trauma network and subsequent trauma centers is still in the developmental phase. In a search for indicators to improve trauma care a benchmarking study was carried out. The performance of Queensland’s first recognized Adult Major Trauma Service, the Princess Alexandra Hospital (PAH) in Brisbane, was compared with the results of the well-established Trauma Registry of the German Trauma Society. This study analysed the whole range of trauma care, from the scene of the accident to discharge from the hospital.

Methods: The study populations were retrospectively identified and extracted from the Queensland Trauma Registry and the DGU Trauma Registry. Both databases contain all primary and secondary admitted trauma patients of all ages, with an Injury Severity Score (ISS) 15, for the year 2005. The collected patient data included demographics, mechanism of injury, details on pre-hospital phase, injury, treatment, complications and outcome.

Results: At the PAH 309 patients with an ISS 15 were treated, compared to 2537 in the DGU Registry. The demographics, trauma mechanisms, ISS and distribution of injuries were comparable. The effects of Queensland’s enormous size showed in the low number of referrals directly from the accident scene: 58% versus 82%, and the long pre-hospital phase: 5 hours compared to 1 hour in Germany. PAH patients less often needed surgery (61% versus 78%), ICU-admission (49% versus 88%) and mechanical ventilation (44% versus 72%). Additionally, the mortality was lower: 10% versus 18%, with an equal time to death, age and injury severity of deaths.

Conclusion: Queensland’s enormous size entails significant implications for trauma care. A large amount of patients have to do with suboptimal care in the first crucial hours after the accident. The relatively low number of in-hospital deaths was presumably due to a substantial number of prehospital deaths, although we are unable to quantify this at present. A well-developed trauma network will enhance trauma care both locally and state-wide.